Purpose
Adolescence and pregnancy are sensitive periods for the development or worsening of anxiety and/or depression. Pediatric clinicians often diagnose pregnancy, but little is known about the assessment and treatment of anxiety and/or depression during this sensitive period.
Methods
We completed a retrospective chart review of patients who presented to an Adolescent/Young Adult Medicine clinic between April 2018 and March 2023 with a positive pregnancy test. Investigators reviewed medical records and abstracted patient data by unique pregnancy (N = 318), including demographic characteristics, pregnancy-related factors, mental health diagnoses, and service use.
Results
Of the pregnancies reviewed, 135 (42.5%) had a diagnosis of anxiety and/or depression while 183 (57.6%) had neither. Overall, 28 (8.8%) had anxiety, 68 (21.4%) had depression only, and 39 (12.3%) had both anxiety and depression. Mental health was discussed during 62.6% of visits though patients with prior diagnoses of anxiety and/or depression (p < .001) were more likely to be assessed. Few patients were in therapy (6.9%) or taking psychiatric medication (8.5%). A higher proportion of those with depression identified as Black and a higher proportion of those with both anxiety and depression identified as White (p < .001).
Discussion
We highlight the need to assess for anxiety and depression in all pregnant adolescents/young adults. We encourage future research investigating patient preferences for mental health supports and strengthening of clinical programs that seek to treat and understand anxiety/depression in this unique population.
Plain language summary
A study of mental health concerns in pregnant adolescents/young adults at an urban outpatient clinic: Why was the study done? Adolescents/young adults who are pregnant may be at greater risk for anxiety and depression compared to non-pregnant peers and pregnant adults. Researchers do not know enough about how common anxiety and depression are in pregnant adolescents/young adults. Researchers also do not know enough about risk factors for anxiety and depression in pregnant adolescents/young adults or what mental health services they use. What did the researchers do? The research team looked at pregnant patients’ electronic medical records. They gathered information about patients’ age, ethnicity, race, information about patients’ pregnancies (e.g., how many weeks pregnant), and whether patients had anxiety, depression, or both. Researchers also recorded whether patients were receiving therapy or medication for anxiety and/or depression. What did the researchers find? The researchers looked at electronic medical records for n = 318 pregnancies. In 28 (8.8%) pregnancies, patients had anxiety, in 68 (21.4%) pregnancies, patients had depression, and in 39 (12.3%) pregnancies, patients had anxiety and depression. Only some clinicians (62.6%) asked about mental health. Pregnant patients who had depression were more likely to be Black and pregnant patients who had anxiety and depression were more likely to be White. Few patients (6.9%) were in therapy or taking medication for anxiety/depression (8.5%). What do the findings mean? Many pregnant adolescents/young adults did not experience mental health concerns; however, about 20% of patients experienced depression, about 9% experienced anxiety, and about 12% experienced both. Clinicians did not ask every patient about mental health at each encounter, so more patients might have been experiencing depression and/or anxiety. The researchers encourage clinicians working with pregnant adolescents/young adults to ask all patients about mental health. This might help more patients connect with a therapist or prescriber.
